It is rightly said that necessity is the mother of invention. This applies to health insurance also. Deteriorating lifestyle patterns and the rising cost of health care in India has paved way for health insurance services. This need has further aggravated by the fact that unlike the West, the social security systems are non-existent in India. The governments have made all the provisions to extract tax from the citizens at all possible points but when it comes to health care and social security, it has not done anything at all.
Thus, it is the responsibility of the citizen to secure himself. But it is not that smooth to get the right health insurance policy. There are over two dozen general insurance companies which are offering different types of health insurance plans in India. Many times, people end up buying health insurance plans which are not relevant for them and which do not help them during the time of need.
Therefore, it bears crucial significance that you understand the nuances of health insurance plans and then only make a decision. Here is a quick list for you.
What all do health insurance plans cover?
Health insurance plans are primarily meant to provide you coverage against hospitalisation and critical diseases. Most plans cover this. But, there are many plans, which do not cover certain types of health ailments. For instance, you can find several mediclaim plans which do not cover blood pressure and diabetes related issues.
The scope of coverage can be different too. For instance, not every plan covers post-hospitalisation expenses. In some the coverage period can be as large as 45 days and in some the period could be as little as one week.
It is your responsibility to check on these matters. If you are relying on the insurance agent who is pursuing you, it can cost you dear at later dates. Agents are interested in making sales and commission. They may show their concern and tend to offer you the best plans, but they reality can be very different. So, just take care of these aspects.
The development of health insurance industry in India has motivated insurance companies to introduce comprehensive plans. A wide range of riders are also available at your disposal. Thus, if you buy a standard policy, you can add on riders which can provide you cover against many other risks such as permanent disability benefit, diabetes coverage, etc.
Do they cover pre-existing conditions?
Most mediclaim plans in India do not cover pre-existing conditions unless specified. Do not assume on this matter. If you are looking for coverage against a pre-existing medical condition, then clarify it at the very first instance. You can compare health insurance plans online and consult with customer care centre through online chat option or telephonic call.
There are plans which cover pre-existing ailments at certain conditions. Generally, there is a pre-specified period under which pre-existing conditions are covered. The cost of such plans is naturally higher than the standard ones.
Can multiple family members be covered under one plan?
Yes, it is possible. You can simply opt for a family floater plan and get your family members covered under a single plan. There are myriad benefits of these plans. The premium is a bit higher but quite less if you go for different health insurance plans for various family members. The collective cost for various plans is much higher.
Family floater plans, at the other end, are cost effective. The most frequently asked question about family floater plans is what happens if one member consumes the coverage limit and another member falls ill. There are solutions to these conditions.
You can top-up coverage limit during the policy period. Of course, you need to pay some additional premium to get the extended coverage.
Can you switch from one health insurance plan to another?
Portability is not limited to the telecom sector only. The Insurance Regulatory and Development Authority of India (IRDAI) has made portability possible in the health insurance sector.
If, due to any reason whatsoever, you wish to change your health insurance service company, you can file an application for the switch. Health insurance is offered by general insurance companies, so far and they cannot reject your claim for portability.
They can try to retain you but at the end, it is your prerogative to make the final decision. If you come across any issues pertaining to your health insurance plan, you can file a complaint at IRDAI’s online consumer grievance redressal system. It is amazingly efficient and you can expect an action within a 15-45 day period.
Nonetheless, the IRDAI has taken tough measures to protect consumer rights and there are all the possibilities that your grievances are resolved by the insurance company itself at the first stage and you do not need to approach IRDAI in that case.
What about tax exemptions?
In the current fiscal year ending March 2015, you can claim for a tax deduction to the limit of Rs 15,000 towards payment of health insurance premium, under Section 80D of the Income Tax Act. From the next fiscal year, this limit is set at Rs 25,000 a year.